Alcohol consumption causes approximately four percent of all deaths worldwide and is responsible for roughly five percent of global diseases. A study of alcohol consumption in Tuscany, Italy has found that alcoholics have significantly higher rates of both general and cancer mortality when compared to the general population.

Results will be published in the February 2012 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

"[We conducted this study of] mortality rates [among] this relatively large group of alcoholics because of our interest in better understanding the risk profile of alcoholism," explained Domenico Palli, head of the Nutritional and Molecular Epidemiology Unit at the Cancer Research and Prevention Institute (ISPO) in Florence, and corresponding author for the study. "The higher number of male alcoholics in our group reflects the distribution of alcohol consumption in the Italian population."

"There have been other studies of the relationship between alcohol and mortality but not with so many addicted people and particularly those with cancer," added Emanuele Scafato, director of the World Health Organization Collaborating Centre for Research & Health Promotion on Alcohol and Alcohol-Related Problems at the Istituto Superiore di Sanità. "From an epidemiological point of view, this is a unique opportunity to examine health experiences and outcomes due to long-term hazardous and harmful consumption of a toxic and well-known carcinogenic that has resulted in alcohol dependence. This is relevant from a public-health perspective in order to formulate caution messages to the public to increase levels of awareness about the need for a healthier lifestyle and really moderate alcohol consumption."

Palli and his colleagues gathered data on 2,272 alcoholics (1,467 males, 805 females), predominantly middle-aged, who were treated at the Alcohol Center of Florence during the period of April 1985 through September 2001, for a total of 21,855 person-years. Expected deaths were estimated by using age, gender, and calendar-specific regional mortality rates.

"Our study has provided strong evidence that alcohol addiction significantly increases the risk of death from several causes in comparison to the general population in a Mediterranean country," said Palli. "The alcoholics seemed to be at greater risk of mortality for specific diseases such as infections, diabetes, diseases of the immunological, nervous, cardiovascular, respiratory, and digestive systems, as well as violent causes. Alcohols role as a dietary carcinogen emerged quite clearly. The highest risks were found for cancers of the pharynx, oral cavity, liver, and larynx, but also the risk of other cancers – esophagus, rectum, pancreas, female breast – was increased."

"This research is certainly a step in the right direction in order to foster awareness not only for addicted people but for the general population as well," said Scafato. "It is also important for health professionals to increase levels of valid information and competent actions aimed at prevention, early identification, advice, and helping people change. It is furthermore one more tool for better dealing with a counterproductive and misleading information spread mainly by commercial interests that always give a positive image of drinkers, portraying drinking as a must behavior. Those who are advised or believe that one glass could be good for the heart, they should also be aware that WHO councils that for many people, females and the elderly for example, just a bit more than a glass increases the risk of 60 diseases and 14 cancers. This is what prevention needs to address in terms of informed choices, keeping in mind that hazardous alcohol use always produces more harm than benefits at the population level."

The results also showed that female alcoholics reported higher survival rates than male alcoholics. "Perhaps female alcoholics are more likely to obtain help and achieve remission, tend to benefit more than men from continued participation in treatment programs, and/or tend to be referred to specific alcohol centre earlier than men, who often are admitted with advanced disease or only when severe symptoms emerge," said Palli.

"Women usually live longer than males on average," added Scafato, "and are much more keen to control their health status; they also tend to have a higher probability of receiving medical interventions due to a different social networking and mutual gender support. "

"Clearly alcohol abuse can compromise the structure and functionality of several human organs, thus directly increasing the risk of death," said Palli. "Other aspects of the characteristic life-style of alcoholics – smoking, drug abuse, promiscuity and a poor diet – may contribute to this high-risk pattern together with reduced health-consciousness."

"These results send a clear message about drinking," said Scafato. "Less is better. Alcohol-related cancer is by definition an avoidable cause of premature mortality, morbidity, and disabilities. It is up to the consumer to adopt a model of consumption that follows existing national guidelines, and respects alcohol-free workplaces, drink/driving laws, and abstaining from alcohol during pregnancy and adolescence. Clinicians and medical doctors should keep in mind the need for early detection of hazardous or harmful consumption. The Alcohol Use Disorders Identification Test is the best option as a general-population level screen."

Calogero Saieva, Gabrie

Funding for this Addiction Science Made Easy project is provided by the Addiction Technology Transfer Center National Office, under the cooperative agreement from the Center for Substance Abuse Treatment of SAMHSA.